大龄儿童先天性肌性斜颈的手术治疗

目的:探讨大龄儿童先天性肌性斜颈的手术治疗方法。方法:采用胸锁乳突肌上、下端切断术加术后牵引治疗大龄儿童先天性肌性斜颈32例,手术平均年龄12.3岁(10￣14岁)。结果:本组32例中随访29例,随访时间1～8年,平均4.8年。从功能和美容两方面进行了术后评估:其中优23例(73.3%),良6例(26.7%),无劣级。结论:胸锁乳突肌上、下端切断术加术后牵引是治疗大龄儿童先天性肌性斜颈的首选手术治疗方式。     

29例先天性肌性斜颈术后复发病例的诊治

目的：对29例先天性肌性斜颈手术后复发病例的治疗进行总结。方法回顾性分析1998年1月至2013年1月收治的29例先天性肌性斜颈手术后复发病例的临床和随访资料。29例均行胸锁乳突肌双极松解术,术后予枕颌牵引1个月,佩戴胸颈联合支具3-6个月。结果29例均获得长期随访（11个月至10年）,患者头颈偏斜症状消失,颈活动正常,效果优良。结论胸锁乳突肌双极松解术,联合术后枕颌吊带牵引、佩戴胸颈联合支具,是治疗先天性肌性斜颈术后复发病例的有效方法。     

颈阔肌旋转肌瓣在先天性斜颈治疗中的应用

作者设计了颈阔肌旋转肌瓣加胸锁乳突肌离断术矫正小儿先天性肌性斜颈,通过29例临床总结,认为此手术方式采用单纯性胸锁乳突肌离断术往往难以达到理想效果的年龄偏大儿童先天性肌性斜颈的一种较好的治疗方法。     

年龄大于5岁儿童先天性肌性斜颈的手术治疗

目的观察大年龄儿童（年龄大于5岁）先天性肌性斜颈的手术治疗效果。方法手术治疗大年龄肌性斜颈患儿37例,切断胸锁乳突肌锁骨头、胸骨头,于乳突处切断胸锁乳突肌止点腱,并充分松解挛缩组织,术后均作枕颌牵引。结果所有病例均获随访,随访时间2～5年,平均随访2．6年,所有患儿的功能和外观均有改善,其中优28例（75．7％）,良9例（24．3％）。结论胸锁乳突肌上、下端切断术加术后牵引是治疗大龄儿童先天性肌性斜颈的首选手术治疗方式。     

颈阔肌旋转肌瓣在先天性斜颈治疗中的应用

作者设计了颈阔肌旋转肌瓣加胸锁乳突肌离断术矫正小儿性肌性斜颈，通过２９例临床总结认为此手术方式采用单纯性胸锁乳突肌离断术往往难以达到理想效果的年龄偏大儿童先天性肌性斜颈的一种较好的治疗方法。     

胸锁乳突肌延长术的相关解剖与临床应用研究

斜颈是指颈部的一侧短于对侧，使头部偏向患侧，颏部则向正常侧上移的一种畸形。斜颈的病因有多种，临床常见的为先天性肌性斜颈，其发病原因为患侧的胸锁乳突肌纤维化和挛缩。治疗斜颈的手术方式已由最初的肌腱切断术，发展为现在的多种方法，其中胸锁乳突肌延长术的优点是保持了颈下段的丰满和胸锁乳突肌的体表颈三角形     

胸锁乳突肌多头切断术治疗成人先天性肌性斜颈

目的探讨胸锁乳突肌多头切断术治疗成人先天性肌性斜颈的方法及效果。方法 2009年3月—2011年2月,收治19例成人先天性肌性斜颈患者。男13例,女6例;年龄16～32岁,平均23.5岁。X线片检查示,12例伴不同程度颈椎侧弯及楔形改变。10例伴患侧面部发育迟缓。4例既往曾行胸锁乳突肌单侧头切断术。患者均采用胸锁乳突肌多头切断术,联合术后石膏托及颈托外固定3～6个月。结果术后患者切口均Ⅰ期愈合,无感染及血肿发生。16例患者获随访,随访时间5个月～2年,平均8个月。患者头颈部畸形均较术前明显改善。术后2周疗效评定:7例无颈椎畸形患者为优;12例伴颈椎畸形患者优1例,良7例,一般4例。术后2周测量患侧胸锁乳突肌乳突尖至胸锁关节距离,无颈椎畸形患者较术前延长(1.88±0.30)cm,手术前后差异有统计学意义(t=6.24,P=0.00),且术后测量值与正常值比较差异无统计学意义(t=1.87,P=0.11);伴颈椎畸形患者术后较术前延长(3.38±0.30)cm,差异有统计学意义(t=11.37,P=0.00),但术后测量值仍低于正常值(t=12.19,P=0.00)。结论采用胸锁乳突肌多头切断术治疗成人先天性肌性斜颈,能明显改善症状,恢复颈部活动功能。     

胸锁乳突肌下端切断术治疗肌性斜颈

目的：本文报告54例肌性斜颈手术治疗经验。方法：对54例肌性斜颈行胸锁乳突肌下端切断术治疗。结果：疗效优者达85．2％,无一例并发症。结论：胸锁乳突肌下端切断术,操作简单、安全,是一种值得信赖的治疗方法。     

自制简易颈托在先天性肌性斜颈术后的应用

先天性肌性斜颈是儿童常见先天性畸形,是因患侧的胸锁乳突肌纤维化和挛缩所引起[1]。治疗上对早期推拿及理疗无效者,多进行胸锁乳突肌切断或部分切除及胸锁乳突肌延长等手术,同时要求术后1～2天即开始使用颈托加以固定,将头部置于过度矫正位[2],因此,术后长期颈托的使用对防止术     

内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈4例报告

目的探讨内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈的方法和疗效。方法2005年1~8月,我院应用内镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈4例,年龄5~11岁,平均8.5岁。患侧腋窝前缘置入10 mm trocar,在颈阔肌筋膜下、胸锁乳突肌胸骨头与锁骨头浅面钝性分离,注入CO2气体(压力6 mm Hg),建立颈前皮下间隙,置入30°内镜。分别在患侧颈后近锁骨上缘处及对侧胸壁近锁骨下缘处置入5 mm trocar至颈前皮下间隙,置入分离钳与电凝钩,距胸锁骨附着处1 cm电凝横断胸锁乳突肌胸骨头与锁骨头的肌纤维束,并松解胸锁乳突肌周围紧张的纤维组织。结果4例手术均获成功,手术时间分别为90、75、70、45 m in。术中出血均<1 m l。术后第1天开始功能锻炼,第2天出院。第1例颈部皮肤轻微电灼伤,2周后痊愈。1例术后出现面部皮下气肿,次日自行吸收。随访2、4、6、10个月,斜颈均矫正,切口小且隐蔽,瘢痕不明显,颈部皮肤弹性良好,对面部表情活动无影响。结论内镜下胸锁乳突肌切断松解术疗效确切,且具有微创的特点,值得临床推广。     

先天性肌性斜颈的两种手术方法比较

目的 探讨先天性肌性斜颈两种手术治疗的方法和效果。方法 回顾性分析86例先天性肌性斜颈患者，其中12岁以内者69例，12岁及大于12岁者17例，根据年龄及畸形严重程度的不同采用不同的治疗术式：胸锁乳突肌下端切断术和胸锁乳突肌上、下端切断术加术后牵引治疗。结果 本组86例中随访72例，随访时间1～7年，平均4．5年。从功能和外观两方面进行了术后评价：12岁以下57例，其中优52例(91．2％)，良5例(8．8％)，无劣级；12岁及大于12岁15例，其中优11例(73．3％)，良4例(26．7％)，无劣级。结论 对先天性肌性斜颈患者，应根据不同情况选择恰当的手术治疗术式，一般均可获得满意的效果。     

内镜下胸锁乳突肌切断治疗肌性斜颈的疗效观察

目的探讨内镜下离断胸锁乳突肌治疗肌性斜颈的效果。方法23例肌性斜颈患儿,年龄1个月～12岁,中位数2岁6个月。右侧腋窝皮纹线内置入5mm trocar,手持镜头将胸锁乳突肌下端胸骨头和锁骨头表面的肌膜钝性分离,充入CO2气体加压至6mmHg,形成皮下空间。在外侧颈下横纹内和前胸横纹处切开3mm分别置入3mm弯钳和电刀尖。电凝或电切横断胸锁乳突肌纤维束,松解胸锁乳突肌周围的纤维组织。结果23例均在内镜下完成手术。平均手术时间51．2min（35～135min）,术中出血量均〈1ml。无损伤周围大血管和神经。1例颈部切口处皮肤轻微电灼伤,2周后自愈。术后行颈部舒展活动训练,术后第1天出院。23例随访3个月～4年,中位时间6个月,斜颈均矫正,疗效优18例,良5例,切口瘢痕不明显,皮肤弹性好,随表情无异常活动现象,无复发。结论内镜下胸锁乳突肌切断治疗肌性斜颈具有微创、恢复快、效果好的优点,瘢痕不明显,美观且不损伤颈阔肌,对表情活动无影响。     

Outcome of treatment for congenital muscular torticollis: a study on ages for treatment, treatment methods, and postoperative therapy

The objective of this study is to review the clinical course after surgical treatment of congenital muscular torticollis and investigate the problems. Based on the treatment strategy of our institution for patients with congenital muscular torticollis, we treated young children with unipolar tenotomy of the sternocleidomastoid muscle, with postoperative use of our original brace, and school age or older children with bipolar tenotomy of the sternocleidomastoid muscle and postoperative use of a simple immobilizing brace, mainly a Philadelphia collar. This study included nine patients who underwent unipolar or bipolar tenotomy of the sternocleidomastoid muscle in our department between November 1990 and April 2006. Of these, four were boys and five were girls. Seven had right and two had left torticollis. The age at surgery ranged from 1 year 6 months to 24 years. Five underwent unipolar tenotomy and four underwent bipolar tenotomy. The study period from the first visit to the present ranged from 1 year 6 months to 18 years 9 months. The evaluation was based on the presence of recurrence and the assessment criteria described by Tanabe (Arch Orthop Trauma Surg 122:489–493, 2002). Three of five patients treated with unipolar tenotomy had a second surgery due to recurrence. None of those treated with bipolar tenotomy experienced recurrence. According to Tanabe’s criteria, among the five patients treated with unipolar tenotomy, two were graded as excellent, two fair, and one poor. And among the four treated with bipolar tenotomy, three were graded as excellent and one fair. Although this study included only nine patients treated and followed-up, more than half of those treated with unipolar tenotomy of the sternocleidomastoid muscle experienced recurrence requiring further surgery. Among those treated with bipolar tenotomy, the outcomes were generally good, and no recurrence was observed. Unipolar tenotomy of the sternocleidomastoid muscle in young children requires special attention with regard to recurrence. We decided to conduct bipolar tenotomy in young children and investigate future outcomes.     

Use of a rugby helmet brace for postoperative treatment of muscular torticollis

Prior to 1992, our postoperative management for congenital muscular torticollis consisted of either plaster cast immobilization or no immobilization, depending on the patient's age and the degree of contracture. However, some patients required further surgery and developed complications. In 1992, we produced rugby helmet braces for postoperative management. The purpose of this study was to compare the clinical results of the previous postoperative management with the results achieved using rugby helmet braces. Twenty-five children aged younger than 6 years underwent caudal partial resection of the sternocleidomastoid muscle. Twelve children aged 6 years and older underwent cranial tenotomy. These 37 patients were divided into 2 groups: no immobilization or plaster immobilization (group A; n=19) and rugby helmet braces (group B; n=18). Canale's method was used for evaluation of clinical results. In group A, the results were good in 12 patients, fair in 4, and poor in 3, whereas all 18 patients in group B had good results. Two patients in group A required further surgery, and complications were observed in 5 patients. In group B, alopecia areata was observed in 1 patient.The rugby helmet brace is easy to put on and remove, providing good retention and allowing for physiotherapy. It provides a useful method of postoperative management for congenital muscular torticollis.     

Surgery for neglected congenital torticollis

Nineteen patients were operated on for congenital muscular torticollis after the age of 1 year. Tenotomy gave good results below 5 years of age and resection of the sternocleidomastoid muscle was satisfactory in most of the older children.     

Surgery for neglected congenital torticollis

Nineteen patients were operated on for congenital muscular torticollis after the age of 1 year. Tenotomy gave good results below 5 years of age and resection of the sternocleidomastoid muscle was satisfactory in most of the older children.     

Ultrasonographic study of the coexistence of muscular torticollis and dysplasia of the hip

The consistent relationship between congenital muscular torticollis and dysplasia of the hip is now widely accepted. However, the coexistence rate of these two disorders has been reported with variations from 0 to 20%. To obtain a more accurate coexistence rate, ultrasound scanner was used as the diagnostic tool for both of these disorders.Sixty-three children (30 boys and 33 girls) younger than 6 months who had undergone ultrasound scanning of both bilateral sternocleidomastoid muscle and bilateral hips were included in this study. Forty-seven children were confirmed to have muscular torticollis, and the remaining 16 cases were diagnosed as postural torticollis. Only these 47 cases were included for analysis of the coexistence rate. Eight children were found with dysplasia of the hips associated with muscular torticollis, which included Graf's type IIa for four hips, type IIb for two hips, type IIIa for one hip, and type IIIb for one hip. From the results of the present ultrasonographic study, the coexistence rate of congenital muscular torticollis and dysplasia of the hip was concluded to be 17%. If only those dysplastic hips (type IIb, IIIa, IIIb) that required treatment were included, the coexistence rate would be lowered to 8.5%.